The need to reorganize health research systems in pandemic crisis: A prospective study

Abstract Background and Aims A pandemic has posed a major challenge to health systems all over the world. All countries have realized that the only way to get real growth and development and solve their problems is to use what they have learned from research. Methods A descriptive and analytic type of study was conducted with the help of experts in the field of health research. The components affecting the research system were obtained via process approach and content analysis methods, and then the position of each component was identified by the Mic Mac technique. Results Seventeen influential structural components in the health research system were identified. The leadership and management components had the most direct and indirect influence among other components. The health promotion component had a greater dependency than the other components. Conclusion All health systems need to provide adequate financial resources and manpower to provide a useful research system. Human resources are the most important inputs to such a system. Components such as the research process, research sustainability, quality, or innovation in research can play a balancing role. Having the right infrastructures for creating, transferring, developing, and getting access to knowledge makes it possible to do systematic science. It is hoped that this science will be used in other results of the health research system, like improving the effectiveness or promoting health.

Conducting research studies and producing science are crucial in today's world, such that the number of articles submitted, the number of researchers, and the volume of investment in the research sector are considered the main indicators of development in evaluating the scientific record of a country. 4 All countries have realized that they have no choice but to invest in and use research findings to achieve real growth and development and solve social, health, and economic problems; without research and using its results, they may not achieve sustainable development in its true sense. 5 The research sector has attracted the attention of individuals in charge of health systems for various reasons. This is because the results of the health research sector are very effective in ensuring and promoting good health for a society, and ignoring them could put people's lives at risk. 6 Numerous studies on health systems show that different research systems have been formed in most countries of the world [7][8][9] ; however, most of these research systems are not effective enough for health systems for various reasons, one of which is the inconsistency and divergence of research in many research systems. 10,11 Another reason is the lack of a general and coordinated policy for conducting research in these systems. 12,13 In many cases, research systems may not be effective due to a lack of financial resources or specialized human resources. 14,15 The so-called reasons show how important it is for every health system in the world to have an integrated research system.
In Iran, after the emergence of the Corona crisis, there was an urgent need to review the research system, and the managers and professors of the universities of the Health Ministry have tried to design a suitable system through several meetings and sessions.
Universities of medical sciences in Iran have similar organizational structures, and there is no difference between universities in different provinces of Iran. Each university of medical sciences, in addition to providing health services, also provides educational and research services. Due to the similar organizational structure of Iranian universities of medical sciences, the results of this study can be generalized to the whole country of Iran. The present study set out to design an integrated pattern for the health research systems and use appropriate quantitative and qualitative methods.

| METHODS
A descriptive and analytic study was conducted; using the opinions of experts in the field of health research, the components affecting the research system were identified, and then the position of each component in the whole system was identified by Mic Mac analysis.

| Participants
The statistical population of this study consisted of administrators and professors of Iranian Medical Universities. Reviewing the studies, an initial list of components was prepared to identify the proper components, and this list was then provided to experts. In semistructured interviews, the collective views of 30 key and expert people in the field of health research were extracted, including the heads and deputies of medical sciences universities, the deans and deputies of the faculties of these universities, and professors of health services' management and health information management.
The so-called individuals were selected based on a purposive sampling method and the following criteria: Individuals who were reluctant to participate in the study or whose access was difficult due to distance or a busy schedule were excluded from the study and replaced by new individuals. Sampling of experts continued until the theoretical saturation of the data was reached, so 30 experts participated in this study (Table 1).

| Data collection
The final list of components of the health research system was obtained using the process approach and content analysis method.
In this step, the six-step Clarke and Braun method was used, including familiarity with the data, creating initial codes, searching for themes, forming subthemes, defining and naming the main themes, and preparing the final list. Expert opinions were identified at three levels of conceptual, structural, and basic components.
Naming structural components were done specifically based on the function of these components. Because the primary goal of this study was to develop an integrated model of the health research system during the pandemic crisis, the third-level (basic) components were excluded from the analysis, and only the first-and second-level components were used to develop the final model.
Third-level components can be used in the operational plans of the research system. For final review and validation, the list of components was given to two scientific experts who were not part of the research sample. Based on their opinions, any changes that needed to be made were made.

| Data analysis
After identifying and classifying the effective components in the health research system, Mic Mac analysis was used to determine the position, influence, effectiveness, and stability of the designed system. The identified components were placed in the n × n matrix, and the variables' effectiveness or influence was scored 0-3 by the experts. Mick Mac matrices were made in four different ways, and then the outputs of the matrices were sorted and analyzed using Mic Mac graphs and maps:

| RESULTS
The demographic characteristics of the study participants are shown in Table 1.
In this study, 17 influential structural components in the health research system were identified. Table 2 shows the categories and titles of these components.
Although the third-level components were not used in modeling, for more information, the frequency of these components is listed in Table 3.

| DISCUSSION
Pandemics have had profoundly short-term and long-term effects on all aspects of health systems. [16][17][18][19] Meanwhile, research systems have also been affected by the coronavirus epidemic. 20 The components of decision making, efficiency, satisfaction, effectiveness, equity, health promotion, and responsiveness to community needs, are among the outputs of the research system.
However, paying attention to the position of these components shows that the dependency of components on health promotion and responsiveness to community needs is greater than other components of this quarter. 32,33 Considering that some of the studied components are located near the coordinate center and play a regulatory role, the research experts developed a conceptual model of the health research system, using the outputs of Table 1  To create a useful research system, it is necessary to provide sufficient and appropriate financial and human resources ( Figure 3).
Human resources are the most important input of such a system, and other inputs are formed based on the needs of this component. 34,35 As a rule, the existence of an effective database is one of the requirements of any research system, and to guide these three components, a management and leadership system is needed. The mentioned components constitute the inputs of the research system in the health system.
It is very important to pay attention to the role of regulators in this model. Components such as research process, research sustainability, and quality or innovation in research can keep research systems balanced in the health sector and ensure the survival of such systems. 36 Also, the sustainability of such a system requires culturalization in each of the health systems.
Classifying research system outputs into three categories of outputs, outcomes, and impacts can be very helpful in policy-making, planning, and evaluation of research systems. Science production and knowledge management are, in fact, the primary outputs of any research system. 37

ACKNOWLEDGMENTS
We would like to thank all participants and experts in this research. The financial resources received had no influence on the data collection, analysis of data, writing of the report and dissemination of information.

CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest.

DATA AVAILABILITY STATEMENT
Not applicable.

ETHICS STATEMENT
This study is derived from a research project approved with code 24176 and the ethical code IR.SUMS.NUMIMG.REC.1400.034 by F I G U R E 3 Conceptual model of integrated health research system components.
Shiraz University of Medical Sciences. After obtaining the necessary permission from the Deputy of Research, the researchers presented the research samples, introduced themselves to the participants, explained the objectives of the research, and reassured them that all the recorded issues would be kept confidential. Afterward, the participants who were willing to participate in the study were selected, and they were also assured that they could withdraw from the interview process at any stage. Other ethical considerations included: (1) obtaining written consent from the experts, (2) assuring participants that the study's results would be provided to them if they so desired, (3) observing the ethical considerations in terms of confidentiality of the data, (4) acknowledging and appreciating all the people who cooperated in the research, and (5) obtaining approval from the ethics committee.

TRANSPARENCY STATEMENT
The lead author Milad Ahmadi Marzaleh affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.